June 20, 2021

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Can the patient have another surgery if bowel cancer has recurred?

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Can the patient have another surgery if bowel cancer has recurred?


Can the patient have another surgery if bowel cancer has recurred?  In recent years, the incidence of colorectal cancer has increased year by year.

As the most common malignant tumor of the digestive system, colorectal cancer is the easiest to prevent, and the early treatment effect is better. As long as regular colonoscopy and timely resection, you can “cut the grass and eliminate the roots.”

However, due to the insufficiency of early screening, the treatment of locally advanced and recurrent and metastatic cases has become a bottleneck in the treatment of colorectal cancer, and it is also a key link that affects the five-year survival rate of colorectal cancer patients.

The most difficult point in the treatment of recurrent colorectal cancer is not distant metastasis (the liver and lung are the most common), but the local recurrence. The former can be cured by surgery, while the latter often has peritoneal dissemination and invasion of adjacent organs (pelvic , Abdominal wall, kidney and ovary, bladder, ureter, etc.), reoperation is difficult and risky, and non-surgical treatments such as radiotherapy, chemotherapy and targeted therapy are not effective.

A 23-year-old male patient developed a mass in his right lower abdomen one year ago and was diagnosed with ascending colon cancer. He underwent radical resection of ascending colon cancer at the local hospital.

Five months later, the tumor recurred and a lump grew locally. Under the doctor’s advice, the patient received local radiotherapy and systemic chemotherapy, but the results were minimal, the lump continued to increase, and persistent abdominal pain occurred.

The medical team inquired in detail about the condition, checked the body, and read the CT. After reading the CT, he gave an affirmative reply that the operation can be done.

Can the patient have another surgery if bowel cancer has recurred?

 

The medical team convened MDT expert consultations many times and pointed out:

  • This is a recurrence of the abdominal wall 5 months after the operation of the fourth stage colon cancer, and the effects of radiotherapy and chemotherapy are not good, indicating that the tumor is highly malignant;
  • Secondly, it can be seen from CT that the tumor is huge and invades the right abdominal wall. If surgically removed, there must be a large abdominal wall defect;
  • Local small intestine aggregation, there may have been invasion of the small intestine and mesenteric;
  • The tumor spreads to the upper right posterior abdominal wall, and the possibility of kidney invasion cannot be ruled out;
  • The patient’s body is weak, and the trauma of the second operation is very large, and the risk of the operation is extremely high;

 

Surgery for more than 5 hours, combined with urology, anesthesiology, and intensive care unit, successfully completed this recurrent colorectal cancer combined with nephrectomy, cytoreductive surgery and abdominal wall defect repair.

The patient recovered well after the operation, and has not relapsed in the past 5 years, and the quality of life has also been improved.

Doctors have repeatedly advocated that the treatment of recurrent bowel cancer must be discussed by multidisciplinary experts, that is, the MDT team. Each patient’s situation is different. After MDT discussion, the clinical pathway and treatment plan are tailored for the patient. For recurrent and metastatic bowel cancer (that is, fourth-stage bowel cancer), as long as the patient’s general condition is good, aggressive surgery Intervention is better than negative treatment. For the MDT team, how to determine which recurrent bowel cancer may benefit from reoperation is the key to the success of the operation.


Patients with the following factors are often prompted to benefit from reoperation:

  • The time between recurrence and the initial operation is longer;
  • The pathological type is better, the first operation is R0 resection (radical resection);
  • Before the first operation, the serum index of tumor such as CEA was low;
  • Recurrent lesions are relatively limited, and imaging evaluation is expected to achieve R0 resection;
  • If the assessment fails to achieve R0 resection, surgery may solve life-threatening complications, such as intestinal obstruction, internal fistula, abscess, bleeding, etc.
  • Sensitive to other treatments after recurrence;
  • The patient has good general and mental state, active treatment willingness and good compliance.

 

 

Local recurrence after colorectal cancer surgery can be performed again in the following ways:

1. Partially enlarged resection again

For isolated recurrent lesions that are not anastomotic, the lesions can be completely resected together with the surrounding normal tissues. While removing the lesion, pay attention to protecting the surrounding organs, such as ureter, vagina, duodenum, pancreas, etc. For the second operation, the lymph node dissection should be implemented according to the specific conditions of the operation, and done as much as possible under the premise of safety.

2. Combined organ resection and reconstruction

In cases of rectal cancer recurrence after surgery, if the surrounding organs are invaded, combined resection of pelvic organs can be considered, including the resection of the bladder, uterus, prostate, ureter and related adjacent tissues. If necessary, combined with resection of large blood vessels and reconstruction of artificial blood vessels, as well as repair and reconstruction of abdominal wall and pelvic floor.

3. Partial sacral resection

In the cases of rectal cancer recurrence after surgery, the tumor often invades the sacrum, and the goal of radical treatment cannot be achieved without resection of the affected sacrum. Before surgery, CT and MRI can be used to determine the extent of tumor invasion to the sacrum. If it is below the S2 level, it can be combined with resection.

4. Palliative surgery

When the above operations cannot be completed, palliative surgery should be paid attention to. It can achieve part of the purpose of controlling symptoms and effectively improve the quality of life of patients with tumors.

1) Provide the following support to patients:

  • Appointment and information summary of MDT clinic for complex bowel cancer
  • Surgical evaluation of MDT
  • Network remote assessment and consultation of complex bowel cancer
  • Tailored clinical pathways and treatment strategies
  • Selective admission for surgical treatment
  • Multidisciplinary surgical teams collaborate to perform surgery
  • Perioperative support and postoperative rehabilitation
  • Quality of life assessment, establishment of medical records
  • Lifetime follow-up

 

2) What is complex bowel cancer:

  • Locally late
  • The tumor is beyond the scope of conventional surgery
  • Combined obstruction or/and bleeding
  • With colorectal fistula, vaginal fistula, urethral fistula
  • Violation of the abdominal wall and pelvic wall
  • With extensive local lymph node metastasis
  • Invasion of prostate and seminal vesicle gland
  • With pelvic abscess
  • Recurrent bowel cancer (after one or more operations)
  • Colon cancer with liver metastasis/lung metastasis
  • Ultra-low rectal cancer requires ultra-low anus preservation or even extreme anus preservation surgery
  • Intestinal cancer combined with other intestinal diseases, such as ulcerative colitis, familial polyposis, multiple bowel cancer
  • Other rare colorectal diseases, such as neuroendocrine tumors, sarcomas, rare pelvic tumors, etc.

 

(source:internet, reference only)


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